Healthcare Provider Details

I. General information

NPI: 1194749770
Provider Name (Legal Business Name): EDWARD E JANUS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3123 W 12TH ST
ERIE PA
16505-3848
US

IV. Provider business mailing address

3123 W 12TH ST
ERIE PA
16505-3848
US

V. Phone/Fax

Practice location:
  • Phone: 814-836-9478
  • Fax: 814-836-8570
Mailing address:
  • Phone: 814-836-9478
  • Fax: 814-836-8570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS003666L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS003666L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS003666L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS003666L
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberOS003666L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: